Don't steer clear when signs of pain persist in bike-related fal

TORONTO - As the bicycle veered toward the curb, his feet firmly clipped to the pedals, Alfred Pietrowski could do little else but brace for impact.

"You have to twist your ankle to get out of the clip to release it," he recalled. "But this was ... it was so sudden."

"The wheel just hit the curb, and then I went over. No time to think about getting my foot out or anything like that."

As the bike struck the curb, Pietrowski landed on his side, bearing down on his right elbow.

An exercise enthusiast who regularly attends spinning classes, Pietrowski had borrowed the same mountain bike from his son to take part in the same charity ride two years prior. But it was a far different experience and outcome during the second go-round last month.

A check-up of the bike shortly afterward revealed the extension he had used to raise the handlebars to prevent from leaning too far forward had not been installed properly.

Pietrowski, 65, pulls the bike into the backyard of his Richmond Hill, Ont., home, north of Toronto, and points to a slight tear in the seat. Aside from that small blemish and the problems with the extension, he said the bike was in pretty good shape. "Much better than me," he quipped.

"I wasn't in really great pain — just discomfort," Pietrowski recalled earlier, sitting inside at his table. "I thought: 'Well, I'll sleep it off, and in the morning, it will probably feel better. ...'"

"Didn't feel better in the morning," he added, with a laugh.

A check-up revealed Pietrowski had damaged the radial head in the elbow joint of his right arm. Within the week, the York University professor had surgery to remove bone shards and have the radial head replaced.

"I have a bionic arm now," the affable academic said, laughing.

Dr. James Waddell, an orthopedic surgeon with St. Michael's Hospital in Toronto, said after upper-limb injuries, elbow injuries are the second most common among cyclists since riders put weight on their arms as they fall.

Waddell said the impact tends to fracture around the head of the radius in the elbow joint, and will always require surgery if displaced in order to have a smooth surface for long-term elbow function. It can have a similar effect if the injury is sustained to the shoulder, he noted.

Most significant or severe wrist injuries will require surgery because the fracture will be into the lower bone of the forearm, into the wrist joint. If left untreated or in the displaced position, it can lead to long-term problems for wrist function, said Waddell.

Depending on the severity of injury and type of surgery performed, the average recovery time is six to 12 weeks, he said.

Waddell chairs the board of the Canadian Orthopaedic Foundation, which is behind the Ortho Connect program. The program matches past and current orthopedic patients by gender, age, surgical procedure or condition as best they can to help address non-medical issues.

"(Patients have) found it's been of great benefit to them in terms of allowing them to get on with the operation with a great deal less anxiety," said Waddell.

While the public perception is that most bicycle injuries occur when cyclists are hit by other vehicles, Waddell said most take place when cyclists fall from their bikes onto the road.

Some may head out on their two-wheeler in open-toed shoes during summer, but Waddell said wearing enclosed footwear — and helmets — is a must.

"A lot of the injuries we see are people wearing sandals or flip-flops riding their bike," he said.

"If they fall, they can injure their bare foot on the roadway, they can get their foot caught in the chain of their bicycle or the spokes ... and we see some quite serious injuries to the feet."

Waddell said cyclists should seek medical attention if they are unable to stand or put weight on the leg without significant pain.

If abrasions from bike-related falls are particularly deep, Waddell said cyclists should probably get them checked because there can be a potential for delayed or difficult healing.

As for testing their upper limb function post-fall, Waddell said if cyclists are able to make a fist and grip firmly with it, their wrist is probably OK. The ability to straighten and bend the elbow without significant discomfort is a sign the elbow is probably OK, too.

But if any of these movements are particularly painful or if they notice a loss of function, Waddell said they should give it a chance to settle down for a few minutes and then try it again. If the problem persists, they should probably get it examined.

Philip Cates had little choice in getting checked out after he was knocked unconscious shortly after embarking on his ride.

The avid Toronto cyclist had headed out for a training ride when the faulty front fork holding the front wheel on his racing bike snapped in two.

His hands were still on the handlebars as he landed.

"Literally, my head took the impact," recalled the 36-year-old.

Cates was fortunate a neighbour saw the incident and called 911.

Despite sustaining multiple facial fractures, Cates said he was fortunate only one bit of bone moved and the rest stayed — and healed — in place.

Cates, who usually rides 10 to 12 hours a week, admits that prior to the accident he'd wear his helmet about 95 per cent of the time. He said the day of the incident was one of those cases where he was trying to head out before the weather changed and left the helmet behind. Cates said he now won't leave the house for a ride without one on.

While he is no longer getting post-concussion symptoms, Cates experienced "the pretty standard stuff," including migraines and dizziness, and even short-term memory loss.

After not touching his bike for about four weeks, he gradually started to ease back into it with rides to work.

"After it happened, sort of the first thing I thought was, 'This isn't worth it anymore,'" Cates said. "Especially now that I have a young child, I thought, 'Well, you know, I can think of better things to do than recovering from bike accidents.'

"But then as time went on, I've raced for so long that I kind of missed it," he added. "I eased back into it and I've tried to do a few races here and there but not at the same level I was doing it at before."

After two weeks in a cast, Pietrowski was back spinning.

While his range of motion was very limited at the beginning, he's made gradual steps in his recovery. He still can't touch his shoulder or have full arm extension, but has resumed normal function of the arm.

While he hasn't gone for a spin outside since the incident, Pietrowski will be making at least one major change when he does return to the road.